title: Aortic root rupture: implications of catheter-guided aortic valve replacement.
abstract: OBJECTIVE
  The safety and efficiency of trans catheter aortic valve implantation (TAVI) has been clearly demonstrated. In high-risk patients, the number of procedures is constantly increasing and in western European countries this procedure is employed in more than 30% of isolated aortic valve replacements. The literature, however, focusing on perioperative aortic root (AoR) rupture is rather limited to just a few reports. The aim of this review is to analyze the pathophysiology of AoR rupture during TAVI, stressing the implications of the morphology of the AoR for this devastating complication.
  
  
  RESULTS
  Currently, perioperative AoR rupture ranges between 0.5 and 1.5% during TAVI, with almost 100% mortality. Recently, valve oversizing and balloon dilatation in a calcified and small AoR were considered as the most important predictive factors for this complication.
  
  
  CONCLUSIONS
  The most fragile unit of the AoR is its anchoring substrate to the ostium of the left ventricle. This membranous structure is not involved in the degenerative process leading to aortic valve stenosis. Due to the TAVI and/or balloon dilatation of the calcium stationed on the three leaflets and their attachment, a lesion may result on this structure. And, as a consequence, there is rupture of the AoR.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Denis
authors.initials: D
authors.lastname: Berdajs
mesh_terms: D017541:Aneurysm, False / Q000209:etiology; D000800:Angioplasty, Balloon / Q000009:adverse effects; D001013:Aorta, Thoracic; D001019:Aortic Rupture / Q000209:etiology*; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001157:Arterial Occlusive Diseases / Q000209:etiology; D006328:Cardiac Catheterization / Q000009:adverse effects*; D003331:Coronary Vessels; D006329:Heart Conduction System / Q000293:injuries; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006406:Hematoma / Q000209:etiology; D006801:Humans; D011474:Prosthesis Design; D012307:Risk Factors